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Biomedical subjects

P Pafko

Publications and source records attributed to P Pafko.

At least 55 records · Page 3Linked to original sources
PubMed2002

[Benign stenoses of the large respiratory airways].

BACKGROUND: Benign stenoses of main respiratory pathways develop usually in patients after intubation or tracheostomy. Incidence of such states is not known, they are frequently diagnosed too late, and there are different views of their treatment. In order to contribute to the improvement of our knowledge of this serious impairment we followed prospectively all patients with this diagnose at our department since March 1998. METHODS AND RESULTS: The group of 31 patients with benign stenoses of non-tumorous origin diagnosed and treated at the TRN of the Teaching Hospital Motol in years 1998 to 2000 consisted of 24 males and 7 females, age median was 52 years. Stenosis was caused in 27 patients by intubation, in 4 patients by some other causes. At admission we performed in 30 patients electrocauterization and dilatation of stenosis, one patient was immediately indicated for surgery. Beside two cases we always achieved sufficient patency of stenosis and weighted indication to surgery. We sent for surgery 15 patients, 10 patients were permanently healed using methods of interventional bronchoscopy, including introduction of stent in 6 cases. From the remaining 6 patients, two of them are planned for resection of stenosis, four are inoperable from various reasons, and two died of causes not related to stenosis. CONCLUSIONS: Based on our experience we recommend as an optimal management of such patients is the dilatation or removal of stenosis and then always to consider resection of trachea. In inoperable cases methods of interventional bronchoscopy should be used. Authors recommend sending all patients intubated longer than 2 days for bronchoscopic examination in interval of 2 months.

Bronchial Diseases↗
PubMed2002

[Personal experience with a bilateral approach in the surgical treatment of primary hyperparathyroidism. (A group of 222 patients with surgery for primary hyperparathyroidism from 1994 to 2000)].

Surgical treatment offers a definite cure of patients with primary hyperparathyroidism. When making the diagnosis of primary hyperparathyroidism the success of a surgical solution depends on the experience and judgment of the surgeon. Our experience with 222 operations and re-operations convinced us on the preference of a bilateral approach, i.e. exploration of both sides of the neck. The ectopic localization of the parathyroid glands, the limited possibilities of an unequivocal interpretation of the histological examinations but also the frequent incidence of thyropathies leads the surgeon, in our opinion, to the complete exploration of both sides of the neck within the framework of the primary operation for primary hyperparathyroidism. This approach leads most probably to the best results. We use an aimed unilateral approach only in old patients who are in a very bad condition where we anticipate a benefit from a short operation.

Adolescent↗
PubMed2001

[Excision of extrahepatic bile ducts in laparoscopic cholecystectomy].

The authors describe the case of an excision of the extrahepatic portion of the right, left and common hepatic duct. Concurrently the authors discuss indications for peroperative drainage of biliodigestive anastomoses. At the Third Surgical Clinic the authors operated during the last three years nine patients with injuries of the biliary pathways during laparoscopic cholecystectomy. In three patients it was possible to suture partial injuries to a T-drain. In six patients with complete severing of the pathways a hepatoenteral anastomosis was established.

Adult↗
PubMed2001

Extra-anatomical reconstruction of the oesophagus.

The authors present the case of a 53-year-old patient with spinocarcinoma of the thoracic part of the oesophagus. The thoracic part of the oesophagus was resected, and the resulting defect was dealt with in several stages with regard to complications. First, the stomach was interposed; subsequently, an attempt was made at reconstruction using the colon and a loop of the small intestine. All these attempts at reconstruction failed, and the resulting condition was oesophagostomy and nutritive jejunstomy. In light of the patient's general condition, past surgical operations and the size of the defect, a stage-wise extra-anatomical reconstruction using tubed flaps was made.

Carcinoma, Squamous Cell↗
PubMed2001

Metabolic characterisation of solitary pulmonary nodules by positron emission tomography with FDG--preliminary report.

BACKGROUND: In the past some authors evaluated FDG-PET as a powerful tool for non-invasive assessment of malignancy of solitary pulmonary nodules (SPN). The aim of this paper is to verify the performance of positron emission tomography with fludeoxyglucose (FDG-PET) in SPN in the conditions of the Czech Republic during the first 16 months of the operation of the PET Centre Prague. MATERIAL AND METHODS: The group of 22 patients with 23 SPN was investigated by dedicated PET scanner due to inconclusive CT scan. Micromorphological confirmation was available in 61%; follow-up (median = 12 months) concerned the other 39% SPN. RESULTS: PET was clearly positive in 11 nodules, all were malignant according to micromorphological assessment. PET was completely negative in 10 nodules, 3 of them were micromorphologically evaluated as benign, the other 7 nodules were followed up without any signs of malignancy. In two cases, PET revealed enhanced glucose consumption, but the pattern was not typical for malignancy. These cases were considered as bronchopneumonia, but till now, they have not been definitely resolved. CONCLUSIONS: Excluding two unresolved cases, sensitivity and specificity of FDG-PET was 100% for malignancy in our series. PET was helpful in medical decision-making in all patients.

Journal Article↗
PubMed2000

[Bronchial anastomoses in lung transplantation].

Bronchial anastomosis is as to the number of complications the most risky anastomosis of transplanted lungs. The most suitable of hitherto used techniques is simple suture with continuous stitches or individual absorbable stitches. The authors prefer the latter technique. They performed a total of 34 bronchial anastomoses. In none dehiscence or stenosis of the anastomosis was occurred. In case of complication of the anastomosis, surgeons often consider the cause of the failure to be ischaemia of the border of the tissue at the time of suture of the anastomosis, corticoid treatment or a poor nutritional status of the patient. The authors cannot confirm the above statements from their own experience, similarly as other authors. They are however aware of the fact that their group of anastomoses is small.

Adult↗
PubMed2000

[Surgery of external hernias at the 3rd Surgical Clinic from 1993 to 1997].

In 1993 to 1997 at the IIIrd Surgical Clinic of the First Medical Faculty Charles University 1271 patients with the diagnosis of external hernia were operated. For classical operations the term herniorrhaphia (HR) is used, for operations with a mesh hernioplasty (HP). For the present study 204 patients were selected operated in 1996 (half the operations were done by the "classical" method, the other half using a supporting mesh). The mean age of the patients was 57 years. For evaluation the sex, age, height, body weight, employment, risk factors, site and type of hernia, number of recurrences before operation, type and period of administered antibiotic, prevention of thrombosis, type of anaesthesia, complications, duration of operation and hospitalization were recorded. After analyzing the results the authors reached the following conclusions: 1. At present there practically does not exist any patient with hernia contraindicated for surgery. 2. For treatment of external hernias a polypropylene net (Prolen) is suitable and its price is reasonable. 3. In obese patients we indicate surgery using a net. 4. In risk patients antibiotic prophylaxis is indicated. 5. Heparinization increases the risk of development of haematomas, therefore in heparinized patients drainage of the wound is recommended. 6. Patients after surgery for hernias in the Czech Republic were hospitalized in 1996 for an unnecessarily long time according to the authors' experience.

Female↗
PubMed1999

[Aspergillus osteomyelitis of the sternum].

The objective of the work was to describe experience with the treatment of Aspergillus osteomyelitis of the sternum. Radical resection of the affected portion of the bone with subsequent filling of the defect of the part of the omentum majus proved useful. Complete healing occurred after 4 months. Based on their own experience the authors assume that resection therapy is the method of choice in pulmonary aspergilloma. In the described case with affection of the thoracic wall its resection with subsequent filling of the defect by the omentum majus proved useful. The operation was implemented in a single stage.

Aspergillosis↗
PubMed1999

Surgical therapy of thymomas.

Surgical treatment of thymomas is indicated for Masaoka stage 1 to 3. We are not in favor of mini-invasive techniques. We consider a gold standard to be sternotomy followed by a tumor removal and extended thymectomy. We are convinced it is necessary to perform sternotomy, tumor removal and extended thymectomy after a thymoma resection through thoracotomy to prevent a late onset of myasthenia gravis. In stages 2 to 3 actinotherapy along with chemotherapy should follow surgery to increase the patient's chances for a prolonged survival (Tab. 10).

Humans↗
PubMed1998

[Rupture of the trachea and main bronchus after intubation].

The authors present two cases of post-intubation perforation of the trachea and main left bronchus resp. One was diagnosed incidentally during thoracotomy, on the second to third day after attempted intubation during which perforation occurred. The patient's life was threatened by the development of ARDS syndrome. The authors emphasize therefore the necessity of acute tracheobronchoscopy when perforation of the major airways during difficult intubation is suspected. Uncertain suture of the pars membranacea should be covered by the oesophagus.

Bronchi↗